The Sexual Victimization of Older Women Living in Nursing Homes

Sexual Violence against Adults Aged 50 Years and Older and Implications for Prevention: A Thematic Analysis of Service Providers' Perceptions

At-risk older adults and older survivors of sexual violence (SV) remain largely absent from SV prevention and intervention, owing to ageism and sexism, as well as other intersectional forms of prejudice, including among service providers (e.g., social workers, healthcare professionals, practitioners in SV organizations, and practitioners who serve older adults). This study explored perceptions, knowledge and experiences with SV against adults 50 years and older. Service providers who work with older adults and/or survivors were recruited, owing to where SV in later life is reported (e.g., healthcare, long-term care, and social service organizations, and to police in addition to SV service organizations), to contribute to the limited research in this area and to advance prevention and intervention. A survey was conducted on SV in later life, exploring knowledge, perceptions and experiences with SV in later life along with potential solutions for prevention and intervention among 126 service providers who worked with survivors and/or older adults. Their responses were thematically analyzed. Five themes were identified: (a) misconceptions of SV in later life and unique barriers to preventing it; (b) needs for knowledge, awareness, research and education; (c) policy and resource development; (d) victim blame and internalized stigma, and (e) ageism, intersectional prejudice and rape culture. The findings offer an in-depth understanding of barriers to prevention, and intervention, and multi-level recommendations for addressing them, which are provided by a diverse group of service providers who have worked with older adults and/or with survivors, reflecting multidisciplinary practice wisdom and experience.

Societal, Organizational, Relational, and Individual Perceptions of Sexual Violence Against Older Adults and Its Prevention: A Systematic Scoping Review

BACKGROUND AND OBJECTIVES

Older adults are not regarded as sexual and are widely excluded from sexual violence (SV) research, policies, and practice; little is known about SV against older adults and its prevention.

RESEARCH DESIGN AND METHODS

An 8-database scoping review explored perceptions of SV against older adults, barriers to prevention, and solutions for prevention. Included were peer-reviewed and gray sources published since 2010, supported by primary research, on perceptions of SV in later life and prevention. A thematic analysis was conducted to explore key themes.

RESULTS

Of 148 potentially relevant sources returned, 95 were fully read after screening titles and abstracts; 19 were critically appraised and 18 were assessed for analysis. Seven overarching themes emerged, surrounding (a) knowledge and awareness, (b) research, (c) policy changes and development, (d) intersectional prejudice, (e) SV being taboo, (f) sociocultural differences, and (g) confusion regarding the definition and nature of SV.

DISCUSSION AND IMPLICATIONS

These findings offer relevant considerations for practice, policy, and research, which will be further discussed.

Forms of sexual assault against older women in the context of acquaintance relationships: An intersectional perspective

This study addresses forms of sexual assault against women in late life (SAWLL) from an intersectional perspective, focusing on acquaintance relationships. Qualitative research was conducted, using in-depth interviews with 18 welfare and healthcare professionals who treated sexual assault survivors. Five forms (themes) emerged, relevant to the identification of SAWLL: (1) Coercive sexual assault in the context of changes brought on by old age, (2) contempt and sexual humiliation based on ageist and sexist social constructions, (3) violation of the older women's dignity in the multigenerational context, (4) life-long incestuous relationships and sexual assault against older women and (5) erotic touching and exhibitionism in caregiving relationships. The revealed forms emphasise the vulnerability of older women who are sexually assaulted in domestic relationships by perpetrators whom they know. These forms can contribute to filling the existing gap in knowledge on SAWLL and promote the visibility of sexually assaulted older women in the justice system. In addition, they can aid law enforcement, health and welfare professionals and policymakers to advance the general understanding of SAWLL as well as improve the response to this phenomenon.

"Who Would Sexually Assault an 80-Year-Old Woman?": Barriers to Exploring and Exposing Sexual Assault Against Women in Late Life

The phenomenon of Sexual Assault against Women in Late Life (SAWLL) has received increasing research attention in recent years. Yet, there is still only scant knowledge on it, compared with research on the sexual assault of younger women. Sexual assault is considered a sensitive topic, generally characterized by a conspiracy of silence. The aim of this article is to explore the barriers that hinder the identification and exposure of SAWLL, as reported by professionals. The research question was as follows: How do welfare and health care professionals present the motives and processes that obstruct exploring, exposing, and intervening in cases of SAWLL? A qualitative research design was used. Participants were 18 experienced welfare and health care professionals engaged in intervention with sexual assault in late life victims as well as offenders. Data were collected through in-depth, semi-structured interviews, which were later transcribed and thematically analyzed. Four themes emerged from the data analysis: (a) Leading Negative Emotions, (b) Lack of Language, (c) Implications of Cumulative and Complex Trauma, and (d) Social Exclusion. Women and professionals alike undergo complementary processes involving silence and silencing. These processes construct a "wall" of barriers, requiring professionals' sensitivity and awareness to deconstruct these barriers. Professional intervention through open discourse with the abused women can break this conspiracy of silence. We recommend that training programs for professionals intervening in cases of elder abuse and neglect will be directed along two paths: The first path should focus on professionals' competence and skills, and the second path should address the women's specific needs. These programs will include a particular module that will specifically address SAWLL. This module should comprise knowledge on typical emotional reactions to SAWLL, the use of language in creating reality, cumulative and complex trauma, and the social construction of ageism and sexism, which lead to social exclusion.

Between sexual assault and compassion: The experience of living with a spouse's dementia-related hypersexuality-A narrative case-study

BACKGROUND

Hypersexuality is one of the behavioral and psychological symptoms of dementia. This symptom can lead to poor quality of life for the person who lives with dementia, as well as for his or her caregiver, who might be exposed to sexual assault.

AIM

This study aimed to highlight the experience of an older woman living and coping with a spouse who exhibits dementia-related hypersexuality.

METHOD

A narrative case-study of a single case was designed, composed of four semi-structured interviews conducted over a 10-month period. The data were analyzed through thematic, structural, and performance analysis.

FINDINGS

Four phases were revealed, depicting the experience of being a partner and caregiver of a spouse with dementia-related hypersexuality: a) "I need help": A distress call; b) "It depends how long I agree to go on with it": Living with the ambiguous reality of dementia-related hypersexual behavior within an ongoing intimate relationship; c) "It's as if I'm hugging someone who's no longer alive": The transition from the previous couplehood identity to a new couplehood identity; and d) "I am just taking care of him as if he is a child": A compassionate couplehood identity construction.

CONCLUSIONS

Living with a partner with dementia-related hypersexuality is a distressing experience for the caregiver-spouse. Yet, positive memories from a long intimate relationship can lead to the creation of a compassionate identity, which supports the caregiving process, and creates a sense of acceptance and meaning making. This, in turn, enables a positive aging experience. These finding have some practical implications for supporting and intervening in such cases.

The Lived Experience of Older Women Who Are Sexually Abused in the Context of Lifelong IPV

The present study explores the lived experience of older women who are sexually abused in the context of lifelong intimate partner violence (IPV). An interpretive phenomenological analysis was used, and semi-structured interviews were performed with 19 older women survivors of lifelong IPV and sexual violence. Three themes emerged: sexual violence shaping lifelong IPV, the occurrence of sexual violence in old age in the context of lifelong IPV, and cumulative insights and reflections on being a survivor of lifelong IPV and sexual violence. The transition to aging has a profound impact on the violent relationship dynamics and this should be considered in practical interventions.

Breaking the Taboo: Sexual Assault in Late Life as a Multifaceted Phenomenon-Toward an Integrative Theoretical Framework

Sexual assault (SA) in late life has been receiving growing attention over the past two decades. It is directed primarily against older women and has been the least frequently reported form of abuse. Despite the growing awareness and body of knowledge on this phenomenon, the theoretical framework is still limited. Therefore, the aim of the present article is to suggest a theoretical conceptualization of the multifaceted phenomenon of sexual assault against women in late life (SAWLL). This conceptualization has been developed through several stages: (a) identification of three grounded fields of inquiry that are relevant to SAWLL: SA, elder mistreatment, and intimate partner violence; (b) classification of SAWLL along four paths: (1) ongoing SA in the context of lifelong IPV; (2) SA beginning in old age in the family within the community, involving spouses, family members, caregivers, dating mates, and so on; (3) ongoing SA, continuing in institutions, perpetrated by family members; and (4) SA in institutions, beginning in old age, relating to staff, residents, and family members; (c) We suggest three additional theoretical perspectives: trauma, a life-course perspective, and social constructionism, which provide further in-depth knowledge for understanding SAWLL. The combination of the three abovementioned stages composes an integrative theoretical framework, addressing SAWLL as a multifaceted phenomenon.

Elder sexual abuse and implicit agism: examining the warm-incompetent bias among mock jurors

Implicit ageist beliefs about the warmth and incompetence of older adults may influence jurors' perceptions and judgments of an older adult's competence in legal cases hinging on capacity and consent, including elder sexual abuse. However, little is known about the nuances of implicit agism in elder sexual abuse cases, and if it can be attenuated. The current study proposed to address these gaps via a randomized vignette design administered to a community sample of 391 US adults. Mock juror participants evaluated an elder sexual abuse case involving an older married couple, in which the victim had dementia. Results suggest that implicit agism was present among mock jurors, consistent with a warm-incompetence bias, and was predictive of mock jurors' guilt ratings. Age- and dementia-relevant jury instructions and mock juror gender were not found to be predictive of guilt ratings. Implicit agism among jurors should be addressed to reduce the potential for implicit age bias to affect elder sexual abuse cases.

Sexually assaulted older women attending a U.K. sexual assault referral centre for a forensic medical examination

There is a paucity of literature on sexual violence against older adults, particularly in the U.K. This work aims to identify and describe the characteristics of alleged sexual assault and subsequent forensic medical examination (FME) for older clients presenting to a large sexual assault referral centre (SARC) in Manchester over a ten-year period. A retrospective analysis of forensic case notes was conducted for all clients (n = 39) who had attended for an FME between 2007 and 2017, and who were aged 70 or over at the time of the alleged assault. The average age of clients was 83 years, all were white, and 95% were female. Two populations were identified: a less frail population who had been assaulted at home by an alleged stranger with greater physical violence alleged, and a frailer population, with a greater incidence of dementia (77%), who were alleged to have been assaulted by a care-giver or fellow resident in a place of care. We note the need for flexibility in the site of FME, the underrepresentation of minority populations in SARC attendees, and difficulties with description of events by clients. We identify several patterns of non-age related anogenital and body examination findings, and offer recommendations for sexual assault services on how they may better cater to older populations.

Victim, Allegation, and Investigation Characteristics Associated With Substantiated Reports of Sexual Abuse of Adults in Residential Care Settings

The purpose of this study was to identify characteristics of investigations of sexual abuse concerning vulnerable adults residing in facility settings that were associated with case substantiation. Data on 410 reports of sexual abuse were collected prospectively from Adult Protective Services (APS) and state licensure agency staff in New Hampshire, Oregon, Tennessee, Texas, and Wisconsin over a six-month period. Specifically, we examined differences between reports that were substantiated and those that were not by comparing characteristics of alleged victims, alleged perpetrators, and aspects of investigation using logistic regression. We found that a relatively low proportion of cases (18%) were substantiated overall. Compared to cases that were not substantiated, cases that were substantiated were more likely to feature nursing home residents, older victims, female victims, and allegations of physical contact between the alleged perpetrator and victim. Despite the high proportion of alleged perpetrators who were facility staff (51%) compared to resident perpetrators (25%), cases with resident-to-resident allegations of abuse were much more likely to be substantiated, accounting for 63% of substantiated cases. In light of these findings, we believe it is important that investigators are trained to handle sexual abuse cases appropriately and that they are able to investigate the case thoroughly, promptly, and with as much information as possible. It is also critical that investigators make substantiation decisions using the appropriate standard for confirmation (e.g., preponderance of the evidence, beyond a reasonable doubt, clear and convincing evidence) as state law dictates.

Elder Abuse

Elder abuse is generally defined as the maltreatment of individuals over the age of 60, although no precise definition exists in the literature. Types of abuse include, but are not limited to, psychological/emotional, physical, sexual abuse, and financial exploitation. Certain risk factors exist leaving an individual more susceptible to abuse, and many obstacles exist preventing the elimination of abuse. There are also identifiable risk factors that increase the likelihood of perpetration of abuse. This systematic review provides an overview of the scope of the problem, types of abuse, risk factors, characteristics of abusers, and key aspects of elder abuse prevention.